EXPLANATORY STATEMENT
Issued by the Authority of the Minister for Health and Ageing
Health Insurance Act 1973
Health Insurance (Home-Based Sleep Studies) Determination 2008
Subsection 3C(1) of the Health Insurance Act 1973 (the Act) provides that the Minister may determine in writing that a health service not listed in an item in the General Medical Services Table (the Table) shall, in specified circumstances and for specified statutory provisions, be treated as if it were so listed. The Table is set out in the Health Insurance (General Medical Services Table) Regulations which are re-made each year.
A determination made under subsection 3C(1) of the Act is a legislative instrument (see subsection 3C(4) of the Act and paragraph 6(d) of the Legislative Instruments Act 2003).
- Health Insurance (Home-Based Sleep Studies) Determination 2008
The Health Insurance (Home-Based Sleep Studies) Determination 2008 (the Determination) will permit the payment of Medicare benefits for home-based sleep studies provided by practitioners who are qualified in the field of sleep medicine.
The Determination provides for a single new interim home-based sleep study service item (item 12250). A home-based sleep study service is an overnight investigation for sleep apnoea for a period of at least 8 hours’ duration in an unsupervised setting (that is, a patient’s home), where the patient has been provided with a portable device (or devices) to record their brain wave activity, their heart rate and their respiratory function while they sleep at home. Recordings from the device/s are provided to a qualified sleep medicine practitioner who analyses and reports on the findings (that is, whether or not the patient has sleep apnoea).
Currently the Table lists items for sleep studies that are conducted in a sleep laboratory setting, which require the continuous attendance of a technician or registered nurse (items 12203 to 12217).
This Determination has been made pending the evaluation of a current application for home-based sleep studies which has been submitted by the profession to the Medical Services Advisory Committee (MSAC). MSAC provides advice to the Australian Government on evidence relating to the safety, effectiveness and cost-effectiveness of new medical technology and procedures. The Determination does not have an end date, but is considered an interim item because it may be withdrawn or replaced once the current application for home-based sleep studies has been formally assessed by MSAC (which may take up to 18 months).
The new item is restricted for use by qualified sleep medicine practitioners because there has been some concern in the sleep medicine profession that an increasing number of practitioners who are unqualified in the area of sleep medicine have been performing home-based sleep studies, despite a lack of evaluated evidence on the diagnostic effectiveness of such studies.
Details of the Determination are set out in the Attachment.
Consultation
Consultation took place with the Australian Medical Association, the Australasian Sleep Association, the Thoracic Society of Australia and New Zealand, the Royal Australian College of General Practitioners, the Rural Doctors Association of Australia and Medicare Australia.
ATTACHMENT
Notes on sections in the Determination
Section 1
Section 1 provides the name of the Determination.
Section 2
Section 2 provides that the Determination commences on 1 October 2008.
Section 3
Section 3 defines terms used in this Determination. A key term is ‘qualified sleep medicine practitioner’ which means a ‘qualified adult sleep medicine practitioner’ or a ‘qualified paediatric sleep medicine practitioner’. These terms are referred to in section 4 of the Determination.
Subsection 3(2) provides that a reference to a provision of an Act or regulations, is a reference to the provision as in force from time to time (as authorised by subsection 3C(3) of the Act).
Section 4
Subsection 4(1) specifies the circumstances in which the Determination applies. The circumstances in relation to the relevant service are:
- for patients less than 18 years of age – the service is rendered by a qualified paediatric sleep medicine practitioner;
- for patients 18 years of age or older – the services is rendered by a qualified adult sleep medicine practitioner.
Subsection 4(2) provides that a person is a ‘qualified adult sleep medicine practitioner’ or a ‘qualified paediatric sleep medicine practitioner’ if they meet certain credentialling or training requirements.
Section 5
Subsection 5(a) provides that a relevant service specified in the Schedule to the Determination will be treated as if it were both a professional service and a medical service for the purposes of the provisions of the Act, the National Health Act 1953 and regulations made under each Act which provide for medical services or professional services.
Subsection f(b) provides that a relevant service specified in the Schedule to the Determination is to be treated as if there were an item in the General Medical Services Table related to the service and specified a fee for that service, being the fee specified in the Schedule to the Determination in relation to the service.
Schedule
The Schedule to the Determination sets out the relevant service, assigning the applicable item number, item descriptor and fee for the service.